PDF(Pubmed)
Abstract：
Community-acquired bacterial meningitis (CABM) morbidity and mortality remains high in those infected. Rapid diagnosis and treatment is paramount to reducing mortality and improving outcome. This retrospective cohort study aims to assess the time from presentation to diagnosis and treatment of vaccine preventable CABM as well as identify possible factors associated with delays in diagnosis and antibiotic administration. A retrospective chart review was conducted of individuals who presented to Columbia University Irving Medical Center (CUIMC), Children\'s Hospital of New York (CHONY), Mount Sinai Medical Center, and Weill Cornell Medical Center with BM due to Haemophilus influenzae type B, Streptococcus pneumoniae, and Neisseria meningitidis between January 1, 2012 and December 31, 2017. Diagnosis was delayed by more than 8 hours in 13 patients (36.1%) and 5 individuals (13.9%) had a delay of 4 hours or more from presentation to the administration of antibiotics with appropriate CNS coverage. All of these patients were also initially misdiagnosed at an outpatient clinic, outside hospital, or emergency department. This retrospective study identified febrile and/or viral infections not otherwise specified and otitis media as the most common misdiagnoses underlying delays from presentation to diagnosis and to antibiotic treatment in those with BM.
摘要：
社区获得性细菌性脑膜炎（CABM）的发病率和死亡率在感染者中仍然很高。快速诊断和治疗对于降低死亡率和改善预后至关重要。这项回顾性队列研究旨在评估疫苗可预防的CABG从出现到诊断和治疗的时间，以及确定与诊断和抗生素施用延迟相关的可能因素。对向哥伦比亚大学欧文医学中心（CUIMC）就诊的个人进行了回顾性图表审查，纽约儿童医院（CHONY），西奈山医疗中心，和威尔康奈尔医疗中心的BM，因为B型流感嗜血杆菌，肺炎链球菌,和脑膜炎奈瑟菌在2012年1月1日至2017年12月31日之间。13例患者（36.1％）的诊断延迟超过8小时，5例（13.9％）的患者从出现到给予具有适当CNS覆盖率的抗生素的延迟超过4小时。所有这些病人最初也是在门诊误诊,医院外,或急诊科。这项回顾性研究确定了未明确说明的发热和/或病毒感染，中耳炎是BM患者从就诊到诊断和抗生素治疗延迟的最常见误诊。
